Provider Demographics
NPI:1568918415
Name:LIFE ADVANCEMENT SERVICES PLLC
Entity Type:Organization
Organization Name:LIFE ADVANCEMENT SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NETTIE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LCAS-A,
Authorized Official - Phone:336-383-9932
Mailing Address - Street 1:1332 CUSHING STREET
Mailing Address - Street 2:1108 GRACADE STREET
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-383-9932
Mailing Address - Fax:
Practice Address - Street 1:1332 CUSHING ST
Practice Address - Street 2:1108 GRACADE STREET
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3322
Practice Address - Country:US
Practice Address - Phone:336-383-9932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10171251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health